This is an application for a K24 Midcareer Investigator Award in aging-related patient-oriented research. The candidate is an associate professor of psychiatry, neurology and epidemiology at the University of California, San Francisco (UCSF) with an established record as a researcher, clinician, and mentor. The overarching aims of this proposal are to identify cognitive trajectories, their predictors and outcomes among elders in their 9th and 10 decade of life. We propose to conduct our aims from two ongoing NIH-funded prospective studies, the Study of Osteoporotic Fractures (SOF) and the Health Aging and Body Composition Study (Health ABC). We will determine the 10- to 20-year longitudinal trajectories of cognitive function of elders living into their 80's and 90's and to identify the predictors, primarily novel biomarkers, of these cognitive trajectories. In addition, we will determine how these different trajectories influence important health outcomes such as functional status, mortality and nursing home placement. The applicant will use her research as a platform for the mentorship of patient-oriented researchers and will promote a multidisciplinary research approach to cognitive aging. Trainees will participate in research seminars, career development and grant-writing workshops, and in formal didactic training including the K30 Clinical Research Curriculum and the newly funded CTSA program at UCSF. Strengths of the candidate include her formal training in research methods, her history of research productivity and NIH funding including several active R01s, and her early track record of mentoring junior trainees. Strengths of the institution include the resources of the K30 and CTSA, several T32 and K12 training grants from which to garner potential mentees, and the availability of resources to foster research of junior investigators. This award will be instrumental in advancing the applicant's research in the epidemiology of cognitive aging and in mentoring the "next generation" of investigators committed to cognitive aging patient-oriented research.